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In the May issue of “Current Opinion in HIV and AIDS” there are 12 articles dealing with issues related to bone conditions in patients with HIV. An introductory editorial by Todd Brown and Patrick Mallon sets the stage for this important topic, which is particularly relevant as our patients become older and are at increased risk for osteoporosis and fracture. Following the editorial is a table of contents of this journal with access to the abstracts of the various reports. In addition, readers of this website should be aware that there is a separate section on Clinical Recommendations that includes one covering “Osteoporosis in HIV and Aging.”
Brown, Todd T.; Mallon, Patrick W.G.
Over the next 15 years, the population of older people living with HIV is expected to increase markedly. In the Dutch ATHENA cohort, for example, the proportion of HIV-infected persons 60 years and older will increase from 8% in 2010 to 39% in 2030, with expected increases in aging-related comorbidities (Smit 2015). Osteoporotic fracture is a quintessential disease of aging whose incidence increases exponentially after age 65–70 years in the general population. It is also a major cause of morbidity, mortality, reduced quality of life, and healthcare expenditure.
Over the past 15 years, evidence has been mounting that the risks of fracture and of osteoporosis among those living with HIV are higher than would be expected based on the contribution from traditional osteoporosis risk factors alone. Similar to other comorbidities in HIV, the pathogenesis of osteoporosis in HIV-infected persons is complicated and multifactorial, with contributions from certain antiretroviral therapies, other coinfections and comorbidities, behavioral risk factors, and chronic HIV infection, with both HIV infection itself and the associated persistent immune dysfunction having an impact. In addition, both frailty and falls risk, issues that transect both older age and HIV, are emerging challenges to those treating people living with HIV.
In this issue of Current Opinion in HIV and AIDS, we have assembled a series of state-of-the-art articles written by experts in the field, with the overall goal of increasing understanding of bone disease for both researchers and clinicians. In contrast to many previous reviews about bone in HIV that attempt to cover the whole topic in 3000–3500 words and therefore are unable to treat topics with appropriate depth, we chose narrow topics that enabled authors to review the literature in detail, exposing inconsistencies in existing knowledge and identifying knowledge gaps to motivate future inquiry. In many cases, we asked the authors to answer a specific question in their review and provide insight and opinion in areas wherein the data is conflicting or emerging.
In choosing authors, we had several goals. First, as both HIV infection and osteoporosis are global medical problems with marked regional differences in the populations affected as well as availability of resources to enable appropriate evaluation and management, we sought authors from around the world and from a variety of resource settings to provide broader and sometimes new insights and opinions in this field. Second, we paired authors who generally do not work together, usually from different countries, to encourage opinion pieces that would reflect a diversity of perspectives, and that will perhaps result in new collaborations in the future. Third, we encouraged participation of junior investigators who are rising stars in the field.
Although there are many fundamental issues in HIV bone disease that are poorly understood, the articles in this issue highlight the rich repertoire of current research in the field, which will help inform the research agenda in the years to come. In this way, clinicians and caregivers can continue to optimize assessment, prevention, and management of HIV-related bone disease and help limit the burden of fracture in the aging population living with HIV.
T.T.B. is supported by NIH/NIAID R01AI093520 and K24AI120834. P.W.G.M. is supported by the Irish Health Research Board (award HRA_HRA-2014-DI-701).
T.T.B. has served as a consultant to Gilead Sciences, Merck, AbbVie, Theratechnologies, and EMD-Serono. P.W.G.M reports grants to his institution and personal fees from Janssen Cilag, grants from GlaxoSmithKline (Ireland), grants and personal fees from Gilead Sciences, grants and personal fees from Bristol Myers Squibb, grants and personal fees from Merck, and personal fees from ViiV, outside the submitted work.
Editorial: Working towards an understanding of bone disease in HIV (original posting of editorial above)
Brown, Todd T.; Mallon, Patrick W.G.
Does systemic inflammation and immune activation contribute to fracture risk in HIV?
McGinty, Tara; Mirmonsef, Paria; Mallon, Patrick W.G.; Landay, Alan L.
How to predict the risk of fracture in HIV?
Yin, Michael T.; Falutz, Julian
Which HIV patients should be screened for osteoporosis: an international perspective
Alvarez, Elena; Belloso, Waldo H.; Boyd, Mark A.; Inkaya, Ahmet Ç.; Hsieh, Evelyn; Kambugu, Andrew; Kaminski, Greg; Martinez, Esteban; Stellbrink, Hans-Jürgen; Walmsley, Sharon; Brown, Todd T.; Mallon, Patrick W.G.
Vitamin D and bone loss in HIV
Hileman, Corrilynn O.; Overton, Edgar T.; McComsey, Grace A.
Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture
Bedimo, Roger; Maalouf, Naim M.; Re, Vincent Lo III
Bone health in HIV-infected children and adolescents
Eckard, Allison R.; Mora, Stefano
Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?
Hoy, Jennifer; Young, Benjamin
Bone health and HIV in resource-limited settings: a scoping review
Matovu, Flavia Kiweewa; Wattanachanya, Lalita; Beksinska, Mags; Pettifor, John M.; Ruxrungtham, Kiat
Tenofovir and bone health
Grant, Philip M.; Cotter, Aoife G.
The protease inhibitors and HIV-associated bone loss
Moran, Caitlin A.; Weitzmann, M. Neale; Ofotokun, Ighovwerha
More than osteoporosis: age-specific issues in bone health
Erlandson, Kristine M.; Guaraldi, Giovanni; Falutz, Julian
Pharmacologic approaches to the prevention and management of low bone mineral density in HIV-infected patients
Negredo, Eugenia; Warriner, Amy H.